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LETTER 



ON 



FEBRILE CONTAGION 



ADDRESSED TO 

DAVID HOSACK, M. D. F. R. S. F. L. S. 

PROFESSOR OP THE THEORY AND PRACTICE OF PHYSIC, AND OF MIDWIFERY AND 

THE DISEASES OF WOMEN AND CHILDREN, IN THE UNIVERSITY 

®F THE STATE OF NEW-YORK., &C. 



BY JOHN W. FRANCIS, M D. 

Professor of the Institutes of Medicine in the University of the State of New- York, Member 

of the Medical and Chirurgical Society of London, of the Literary and 

Philosophical Society of New-York, kc. 



NEW-YORK : 

PRINTED BY CLAYTON AND FANSHAW, 
No. 62 Pine-street. 

1816, 






n 



XT A * 



NOTICE. 

During the Writers late residence in Great Britain, 
finding the question, Whether the human constitution is 
susceptible of a second attack of Yellow Fever ? occu- 
pying a large share of the attention of the medical pro- 
fession, it occurred to him, that the ample experience en- 
joyed by the physicians of the United States, would go 
far in settling this controversy. With the view of call- 
ing the attention of American Practitioners to this sub- 
ject, and of obtaining the results of their Observations, 
the following Letter is published. 

New-York, Dec. 1816. 



LETTER. 



London, June 16, 1816. 

Dear Sir, 

Within a few days I set out for Bristol, and in 
all probability this is the last letter you will re- 
ceive from me dated London. The present com- 
munication might be devoted to many interesting 
subjects medical and philosophical j but I am in- 
duced from several considerations to restrict my 
attention particularly to one. You have long 
been acquainted with the important controversies 
that have existed on that grand subject of medi- 
cal disputation, contagion; with the various and 
contradictory opinions that have been promul- 
gated as to its nature and effects ; and with the 
manner in which those controversies have been 
conducted, especially by American physicians. 
The question of contagion and infection has also 
occupied, as you well know, a large share of the 
attention of the medical writers of Great Britain, 
especially within the last few years. Much less 
diversity of sentiment, however, exists in this 
country than in our own, and in the discussion 



6 

much less of asperity has been manifested. A 
single exception occurs in the case of Dr. Ban- 
croft in his late " Essay on the Disease called 
Y ellow Fever :" a work intended by the author 
to prove that this form of fever is occasioned by 
the operation of marsh miasmata, and is non-con- 
tagious ; and of which performance it is due to 
the talents of the author to admit that he has dis- 
played great learning and research. As one 
practically acquainted with the disease during its 
visitations in America for a period of more than 
twenty years, your own ample experience will 
have enabled you at once to perceive the fallacy 
of such speculations. Indeed, the volume of Dr. 
Bancroft has most materially aided in the esta- 
blishment of the very doctrines which it was his 
object to overturn. Few writers seem to have 
entered the field of controversy with stronger 
prejudices, and, perhaps, none have communicated 
their thoughts with less deference to authority and 
in more illiberal language. It would appear to 
be the opinion of Dr. Bancroft, judging from his 
conduct, that gross invective and personal abuse 
may supply the place of well authenticated fact 
and legitimate deduction. 

The revival in England of the controversy re- 
lative to the specific form and contagious nature 
of yellow fever has been the means of giving birth 
to several works of great practical value, and in my 



7 

opinion, of deciding the great question ; if indeed 
any thing had been wanting after the laborious in- 
vestigations of yourself and of other American phy- 
sicians. The volumes of Sir James Fellowes and 
Dr. Pym have just made their appearance here, 
and may not yet have reached you. The former 
author has published the results of his practice 
under the title of Reports of the Pestilential Disorder 
of Andalusia, which appeared at Cadiz in the years 
1800, 1804, 1810 and 1813 ; with a detailed account 
of that fatal Epidemic as it prevailed at Gibraltar 
during the autumnal months of 1 804, Sfc. : the latter 
under the name of Observations upon the Bulam 
Fever which has of late years prevailed in the West- 
Indies, on the coast of America, at Gibraltar, Cadiz % 
and other parts of Spain : with a collection of facts 
proving it to be a highly Contagious Disease. As 
officers of high trust in the medical Department 
of the Army, they have enjoyed opportunities of 
unwonted observation : the manner in which they 
have drawn up the respective accounts of their 
labours is highly satisfactory, and the accuracy 
of each work is fully confirmed by official docu- 
ments. Sir James Fellowes, as long ago as 1795, 
had numerous opportunities of witnessing the 
pestilential fever which committed such ravages 
among the British soldiery of St. Domingo, and 
he describes the Peninsular fever as appearing 



8 

under a similar form of malignity and showing, 
many of the strongly marked characters of the 
St. Domingo fever. His history of the origin and 
progress of the disease clearly points out that 
there is a real foundation for the distinction be- 
tween fevers arising directly from the miasmata 
of marshes and decomposed vegetable matter, 
and those that are the offspring of human effluvia 
or specific contagion. The account furnished by 
Dr. Bancroft under this head is clearly proved to 
be erroneous, and his statements, deficient as they 
are in the most essential requisites, will have lit- 
tle weight when compared with the judicious re- 
lation of the Spanish Professor Arejula. In his 
observations on the disorder called the Walcheren 
fever, which prevailed so fatally among the troops 
of Zealand in 1809, and after their return to 
Great Britian, and which disease, notwithstanding 
the volume of Pringle,* has most absurdly been 
pronounced by some writers to be the yellow 
fever, Sir James maintains that it possessed no 
contagious property, at least no evidence existed 
that the complaint ever had been propagated 
or communicated to those in attendance upon 
the sick. 4; This fact," says he, " was confirm- 
ed by my own experience, and by the testi- 

* Diseases of the -Army. 



mony of all the medical officers of the army." 
" On the other hand," adds Sir James, " the nu- 
merous facts which have been recorded of the 
contagious nature of the pestilential fever of Spain 
are incontrovertible ; they are detailed with sim- 
plicity and truth, and they must speak for them- 
selves."* 

Dr. Pym, in his Observations, has attempted 
to prove that the fever of Gibraltar was the same 
as the Bulam fever, so happily described by the 
learned and distinguished Chisholm ; that it is a 
disease totally distinct from the bilious remittent 
fever of warm climates ; that it has no connec- 
tion with or relation to marsh miasmata ; that it 
appears in the West-Indies only under peculiar 
circumstances ; that it is contagious, and under 
a certain degree of temperature may be propa- 
gated from one country to another ; that it attacks, 
in a comparatively mild form, natives of a warm cli- 
mate, or Europeans whose constitutions have been 
assimilated to a warm climate ; and that it differs 
from all other fevers, in having its contagious pow- 
ers increased by heat, and destroyed by cold, or 
even by a free circulation of moderately cool air. 
According to Dr. Pym, under the name yellow 
fever, have been confounded three fevers, which 

* Introduction, p. xxii. 



10 

he considers as totally distinct. The agency of 
marsh effluvia, I have already observed, he wholly 
rejects as a cause of the Bulam, Gibraltar, or real 
yellow fever. This you will perceive is striking at 
the root of that most pernicious error that has been 
so zealously and so widely propagated, notwith- 
standing the evidence of facts to the contrary, and 
the happy nosological distinctions made long since 
by such authors as Blane, Chisholm, Jackson, 
Lempriere, Clark of Dominica, Stewart, Bard, and 
numerous other practical observers of undoubted 
veracity. For I believe you will agree with me 
that from the want of a due discrimination on the 
part of many writers who have professed to de- 
scribe the fevers of the United States, as they 
have prevailed in our sea-port towns and in dif- 
ferent inland places of our country, have proceed- 
ed most of the dissentions that have existed on 
this subject. This want of discrimination too 
may justly be considered adequate to the pro- 
duction of many of the histories of the diseases of 
America that have appeared, and in which we 
find confounded fevers arising from dissimilar 
causes, characterised by a different train of symp- 
toms, and varying most essentially in the methods 
of treatment they require.* Dr. Pym's is no feeble 



* This language, I feel assured, will not be deemed too strong 
by those who impartially compare the different accounts of the 



11 

attempt to counteract the influence which the 
unwarrantable opinions of Dr. Bancroft may have 
had in relation to this point. 

But I have to solicit your attention to a much 
more important circumstance made known in the 
volumes of Dr. Pym and Sir James Fellowes, and 
to communicate which this letter has been written. 
Dr. Pym, who had the advantage of seeing the 
disease not only in Europe but in the West-Indies, 
contends, that the Bulam fever attacks the human 
frame but once; and supports this position with 
the strongest proof. I will not do injustice to his 
statements by attempting to abridge them. Irre- 
fragible evidence is advanced by Dr. Pym, that 
the Gibraltar, West-India or Bulam fever, (the 
malignant pestilential fever of Chisholm) are the 
same disease. In a subsequent essay, Dr 
Pym has enlarged on the subject of the disease 
affecting the human body but once. I must be 
indulged in one or two extracts. 

"At Gibraltar, during the prevalence of the 

fevers which prevail in the interior of our country, and more 
especially those that have made their appearance in the vicinity 
of lakes with the histories that have been given of the pestilence 
as it has exhibited itself in New-York, Philadelphia, Boston., 
and other sea-ports and places within the United States. To 
consider the several kinds of fevers as grades only of one and 
the same disease, is a retrograde movement in medical philosophy, 



12 

disease in the years 1810, 1813, 1814, there was 
no well authenticated instance of a second attack : 
every person escaped it, who had had it at any 
former period : and this fact is now so well esta- 
blished there, that among the quarantine regula- 
tions against the introduction of the disease this 
year, (1815,) all the troops who have not passed it are 
encamped, while those who have passed it are doing the 
duty of the town. At Cadiz, Carthagena, and Ma- 
laga, the fact of persons not being liable to a se- 
cond attack of this disease, is considered to be as 
firmly established as it is in the small-pox." 

" Two more proofs of the Bulam fever not at- 
tacking a second time, were in the 70th and 55th 
regiments. The first suffered severely from the 
disease in the West-Indies, in the year 1794, and 
returned to that climate from Europe in the year 
1800, filled up with new officers, with the exception 
of six, viz. Col. Dunbar, Major Elliot, Captains 
Johnstone, Lawrence, Hutchinson, and Boat, who 
had had the fever at a former period in the West 
Indies, and who now escaped it, although the corps 
buried ten of the newly appointed officers in a very 
short time." 

" Upon a moderate computation, there were 
one hundred and fifty officers (civil and military,) at 
Gibraltar, who had not had the disease before, 
and twenty-five who had passed it in the West 



13 

Indies ; and making an allowance for one or two 
doubtful cases, where the disease was so mild as 
not to confine the patient to the bed, one hun- 
dred and forty-five at least out of the one hundred 
and fifty were attacked by it, while every indi- 
vidual of the twenty-five who had it before es- 
caped it." appendix to Dr. Pym^s Observations. 

This same peculiarity marked the pestilential 
fever of Spain. According to Sir James Fellowes, 
it never has been known to attack the same per- 
son a second time in that country. " This fact," 
says Sir James, "which was first observed by the 
native practitioners, has now been confirmed by 
the experience of several years, and by the con- 
current testimony of all the surviving inhabitants 
of those places, where the disorder had most 
prevailed." Introduction, p. xxiii. 

I have dwelt so long on the performances of 
Sir James Fellowes and Dr. Pym, as almost to be 
deterred from referring to any other authority ; 
yet I cannot forbear making a short extract from 
an account of the epidemic fever which occurred 
at Gibraltar, and for which the public are in- 
debted principally to Dr. Gilpen, one of the in- 
spectors of the hospitals. The paper throughout 
is of singular merit, and eminently calculated to 
do away the doubts of the sceptical, and strengthen 
the faith of the wavering. It is gratifying to the 



14 

philanthropist to read the answer given by Dr. 
Gilpen to the eighteenth query, addressed him 
by the Medical Board of the army. 

" In private houses, in most cases," replies Dr. 
G. "the attendants were attacked. There were 
undoubtedly many exceptions in the hospitals ; 
but it was to be accounted for, as, generally 
speaking, the attendants were persons who had 
had the disease previously either in the West 
Indies, or in Spain, or here, in 1804. At the com- 
mencement of the disease last year, it was cal- 
culated that there was about five thousand per- 
sons within the walls who had previously passed 
through it; and, after careful inquiry, there does not 
appear to be one well authenticated case of a per- 
son's having received the infection a second time. I 
heard, indeed, of three or four ; but as the nature 
of the previous fever could not be exactly known, 
these exceptions have but little weight in so mo- 
mentous a question. The exemption from a se- 
cond attack, I am credibly informed, is firmly be- 
lieved in Spain. At Cadiz, last year, though the 
fever put on the very worst symptoms, and de- 
stroyed the patient frequently in forty-eight hours, 
the deaths did not exceed, in a population of up- 
wards of seventy thousand, fifty a day ; and these 
were chiefly strangers. The Spaniards are so 
fully convinced they cannot receive the infection 



15 

a second time, that having passed the disease is 
matter of great rejoicing among them: and a me- 
dical certificate of the fact, is a sufficient pass- 
port into an infected town, which they enter with- 
out the smallest apprehension." Consult the 
Transactions of that active and distinguished as- 
sociation, the Medical and Chirurgical Society of 
London, vol. 5, for more ample details. 

The immunity of the constitution from a second 
attack of yellow^ fever, is a peculiarity so strik- 
ingly characteristic of most disorders of an ac- 
knowledged specific nature, and of such great 
practical interest both in a social and political 
point of view, that it is extraordinary it should 
have met with so little notice before Professor 
Arejula made mention of it in the year 1806. 
" The yellow fever of Andalusia," says Arejula, 
(I avail myself of the translation of his account in 
Sir James Fellowes? Reports, p. 67.) " attacks per- 
sons but once in their lives, and it is of great im- 
portance to the physician to know this, in order 
to form his prognosis and his plan of cure, as well 
as for the individual who may have passed 
through this disorder, that both of them being as- 
sured of this fact, may step forward without fear 
to the relief of their fellow creatures who may 
hereafter be afflicted with so dreadful a malady." 
Dr. Pym, however, enjoys the reputation of being 



16 

the first English physician who promulgated this 
principle. I have not the sources of information 
at hand to enable me to determine how many of 
the writers on the malignant fever, as it has pre- 
vailed in our country, have entertained this opi- 
nion, though I well recollect Dr. Lining to have 
been one ; as may be seen in his account of the 
fever of Charleston, published more than sixty 
years ago in the Edinburgh Physical and Literary 
Essays, volume second. In the interesting cor- 
respondence on the yellow fever which was main- 
tained a short time anterior to this period by Dr. 
John Mitchell, of Virginia, and Lieutenant Go- 
vernor Colden, of New- York, nothing is alluded 
to from which we might infer their knowledge of 
this law of the disorder. See the American Me- 
dical and Philosophical Register, vol. 1st. and 4th. 
In the Facts and Observations of the College of 
Physicians of Philadelphia, on the nature and ori- 
gin of the pestilential fever, after establishing the 
identity of the yellow fever which existed in that 
city in 1793, 1797 and 1798, with the West India 
pestilence, the College state, that it is a circum- 
stance that deserves particular attention, that 
" very few, if any, of the Creole French in this city, 
[Philadelphia,] suffered from the contagious ma- 
lignant fever which prevailed here in 1793, 1797, 
and 1798, though the disease was introduced into 



17 

their families ; and children born in this country 
of Creole parents, died with it last autumn, while 
the parents and the children born in the West 
Indies were entirely exempt from it." We look 
in vain, if my memory serves me, for any thing of 
the same sort in the Additional Facts and Obser- 
vations, a subsequent publication of the College 
of Philadelphia. 

In the Sketch of the Malignant Contagious Fever 
as it appeared in the same city in 1793, Dr. Cath- 
rall observes, "it does not appear to affect the 
same person twice. Although careful enquiry" 
adds he, " has been made by several of my medi- 
cal friends and myself, it only appears that some 
of the patients had a slight relapse of fever, but 
without any of the distinguishing symptoms of the 
disease, and very soon recovered." It is much to 
be regretted that the several histories of this dis- 
ease published by that able medical annalist, the 
late Dr. Rush, should have been so confused and 
unsatisfactory on so momentous a matter. In his 
account of the bilious yellow fever of 1793, you 
will, nevertheless, find that the refugees from the 
French West Indies " universally escaped the 
disorder," though this was not the case with the 
natives of France who had been settled in the 
city, On the other hand, Dr. Currie of Phila- 
delphia, in his treatise on the Synochus Ictero- 
des, states, that several instances occurred of the 

3 



18 

disease affecting the same individual a second 
time, and under circumstances so unequivocal 
that it could not he fairly ascribed to a relapse. 
This assertion, you will see, is not strongly made, 
and may be deemed rather matter of opinion than 
matter of fact. 

Dr. Currie also tells us that the French West 
Indians, particularly those from St. Domingo, al- 
most to a man escaped the disorder, though they 
made use of no precaution for the purpose, " while 
those from France were as liable to it as the Phi- 
ladelphians." Nothing in relation to the security 
from a second attack of the disease is advanced by 
the late Professor Bayley, in his excellent volume 
on the Epidemic Fever of New- York in 1795, 
though in the Collection of Papers published by 
Mr. Webster, a writer on the epidemic of New- 
York, of the same year, alleges that he knew not a 
decided instance of an individual labouring under 

a second seizure. But at present I am not duly 

prepared to enlarge on this point, by reference to 
other American authorities. 

Dr. Pym has referred me to a passage in Sal- 
vages on this disease, in which it is asserted that 
it operates upon the constitution but once. Ty- 
phus icterodes contagiosus est. Albos tantum, max- 
ime peregrinos ex regionibus frigidis advenas, In- 
dos, Hybridos, mulatros omnes, exceptis infanti- 
bus, una tantum vice afficit : nigri vero ab eo mor- 



19 

bo nonquam afficiuntur." See Nosologia Metho- 
dica, torn. 1. p. 316, of the quarto edition of 1768. 
Does your own extensive experience in the ma- 
lignant epidemic of New-York, agree with the 
opinion that the human constitution is invulnera- 
ble to a second attack of yellow fever, and cor- 
responding in this respect with small pox, and 
other specific disorders ? In answer to this ques- 
tion, which has been frequently put to me by prac- 
titioners of medicine in England, I have uniformly 
ventured to assert that it holds good as a general 
fact. Those who have once had the disease are 
certainly less susceptible of its influence a second 
time. 

Permit me now to make known to you the im- 
portant results of the recent deliberations of two 
of the most distinguished medical associations of 
this kingdom. The decisions of the Royal Col- 
lege of Physicians of London, and of the Army 
Medical Board are at length brought to a close. 
These two learned bodies, alike distinguished for 
scientific attainment and practical knowledge, 
have been for a considerable time past devoted 
to a consideration of all the facts connected with 
the nature and character of the yellow fever, par- 
ticularly as it has of late years appeared in Spain. 
The Royal College have pronounced that the, 
yellow fever is a highly contagious disease, which 
decision they have reported to the Lords of the 



20 

Privy Council. With respect to its attacking the 
human frame but once, they say they think it ex- 
tremely probable, but that upon a point of such im- 
portance they cannot venture to give a decided 
opinion. The Army Medical Board, at the head 
of which presides Sir James McGregor, have also 
given it as their opinion, that the yellow fever is 
in its nature contagious; and they further add 
their conviction, that the fever of Spain is not 
only strictly contagious, but that like other disor- 
ders of a specific character, it affects the human 
frame but once. I have been kindly favoured 
with an abstract of these proceedings, and I here- 
with enclose an extract from the official report 
upon Dr. Pym's publication, by the Army Medi- 
cal Board. The operation of climate, soil, and 
other local causes, in adding virulence to febrile 
contagion, may be considered almost an axiom in 
physics ; and the necessity of a strict adherence to 
your improved system of quarantine laws, and all 
municipal regulations for the purpose of domestic 
cleanliness, cannot be too strongly enforced. On 
this subject the Royal College and the Army Me- 
dical Board are united in opinion. 
(COPY.) 

EXTRACT FROM THE REPORT UPON DR. PrSi's PUBLICATION BY 
THE ARMY MEDICAL BOARD. 

Army Medical Board Office, 6th May, 1816. 

" It is due to Dr. Pym to state, that we consi- 
der him to have been the first English medical 



-*§** 







21 

man who promulgated the opinion, that the dis- 
ease in question (the Bulam fever,) is capable of 
attacking the human frame but once ; and if that 
opinion be correct, which we believe it to be, it is 
certainly an important fact, and led Dr. Pym to 
employ those persons as attendants on the sick, 
who had undergone the disease, and therefore 
were not likely to be affected by the contagion of 
it, and thus probably saved many lives. Under 
these impressions, we beg leave to recommend 
the industry and research displayed by Dr. Pym 
in his book, to Lord Palmerstone's favourable 
consideration. 

" Signed, 

" J. m'gregor, 



" W. S0MERV1LLE." 



The advocates for the unity of disease will, I 
believe, find it insuperably difficult to reconcile 
with their theory, the facts which I have thus has- 
tily communicated to you ; while the fundamental 
principle, that there is a radical difference be- 
tween remitting fever and yellow fever, between 
fevers depending upon marsh miasms as their 
source, and those that take their rise from human 
contagion; in short, that yellow fever is a distinct 
idiopathic disease, acquires additional support. It 
may not therefore be of disservice to make known 



22 

the purport of this letter. The doctrine maintain- 
ing that different fevers are of one common origin, 
is in reality so unfounded in fact and so pernicious 
in its consequences, that the sooner it is discard- 
ed, the better will it be for the interests of huma- 
nity. 

Before I conclude, permit me to add a few lines 
on a subject not wholly foreign to the nature of 
this letter, the plague. The account of the origin 
and progress of the plague in the island of Malta, 
in the year 1813, drawn up by Dr. Calvert, physi- 
cian to the forces, and printed in the 6th volume 
of the Transactions of the Medical and Chirurgi- 
cal Society of London, is a document of great va- 
lue. The reasoning of the author, deduced from 
the evidence which a faithful narrative affords, 
seems to be very satisfactory. Contact, he main- 
tains, is the most certain mode of communicating 
the disease, but he is inclined to deny that it is es- 
sential to the propagation of the contagion. 

"It appears to me, says Dr. Calvert, that this 
contagion or principle of plague is diffusible in the 
atmosphere to a distance greater or less from an 
infected body, according to the climate and sea- 
son of the year, and possibly to Qther peculiar 
states of the atmosphere, with which we are unac- 
quainted ; that in the spring or summer season a 
single infected person is sufficient to contaminate 
the air of a whole city ; and that those who hap- 



23 

j£>en to be then exposed to febrile causes or other- 
wise predisposed are the first to become its victims. 
That these newly infected persons generate a fresh 
supply of poison, increasing its strength and influ- 
ence, till at length it becomes so powerful, that 
nothing but the winter season will entirely put a 
stop to it." 

The various reports that have been so indus- 
triously circulated concerning the contagiousness 
and non-contagiousness of the plague, especially 
as it prevailed in the army of the East, and the 
contradictory statements that have been made re- 
lative to Baron Desgenettes, induced me, while in 
Paris in the spring of 1816, to seek an interview 
with that gentleman, in order to ascertain the truth 
on this interesting subject Dr. Delile, the com- 
panion of Dr. Desgenettes as a member ^of the 
Institute of Egypt, accompanied me. What prac- 
tical advantage may arise from inoculation for the 
plague we are not yet able to state; that the experi- 
ment is not Without great danger is sufficiently well 
ascertained. The Baron distinctly declared that 
it had ever been his settled opinion that the plague 
was a contagious disorder; that his. extensive ex- 
perience as an officer of the medical staff, had 
only served to confirm him in that* opinion ; and 
further expressed much surprise, that any account 
should have been made public representing his 
views in a different light. The Baron innoculated 



24 

himself with the matter of plague, though he felt 
persuaded that the disease was of a specific cha- 
racter, and had almost hourly evidence of its con* 
tagious effects : but more fortunate than the in- 
credulous Whyte, he did not fall a victim to the 
experiment. 

I am aware how confidently the case of Dr. 
Whyte has been denied. So far however from 
any doubt being entertained by the medical phi- 
losophers here, as to the accuracy of the statement 
of his inoculating himself with the matter of plague, 
it is well known that his preconceived notions of 
the nature of that pestilence, were the cause of 
his rashness and premature death. Of this I have 
been assured by personal communication with Sir 
Gilbert Blane and Sir James M'Gregor. 

When I took pen in hand, 1 did not expect to 
produce so long and tedious a letter. My apolo- 
gy must be the nature of the subject, interesting, 
beyond all others, to an American physician. 

With due respect I remain, dear Sir, 
Your friend, 

JOHN W. FRANCIS, 
Dr. David Hosack, 

New- York. 



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